Long list of possibles for microscopic amount of blood in urine
Ask Dr. Keith Roach M.D
DEAR DR. ROACH: My question is about microscopic hematuria. I see a rheumatologist for sarcoidosis. In February 2018, I had various lab tests, including a urinalysis. That test and several since then have shown microscopic hematuria. The rheumatologist sent me to a urologist, who did scans and a scope of the bladder up through the right kidney. There’s a slight stricture of the right ureter. My biopsies were negative. Tests and scans continue to be OK except for the microscopic hematuria. I am a 60-yearold woman. Is the hematuria a cause for concern? — K.E. ANSWER: “Hematuria” means “blood in the urine.” “Gross” hematuria means there is so much blood that it changes the urine color, while “microscopic” hematuria is recognizable only in the laboratory. Blood in the urine can come from anywhere in the urinary system, and there is a long list of possibilities. Although the cause is sometimes never found, your physician should consider urinary tract infection, kidney or bladder stones, and, in the right age group, cancer of the kidney and bladder. CT scans and cystoscopy are commonly performed tests, and the negative result in your case is reassuring. You have one more reason to have hematuria than others, and that is the sarcoidosis. Sarcoidosis is a condition that can affect any tissue in the body with abnormal clumps of cells called granulomata. (Just one is called a granuloma.) While the lungs are the most common site for sarcoidosis, it can affect the kidney, causing hematuria. Sarcoidosis also can cause kidney damage, resulting in a high creatinine, so that should be tested. Severe kidney disease from sarcoidosis may be treated with prednisone, but you should see an expert (nephrologist) to consider this diagnosis. The majority of people with small amounts of blood in the urine with no documented reason for it, including the cystoscopy and scans you had, will not have serious disease. However, it is probably still prudent to keep an eye on the kidneys and bladder periodically. *** DEAR DR. ROACH: I was just told that I have brittle veins. I have exhausted every place I can think of to find out more about this condition. What is it? What causes it? What should I do? — T.M.G. ANSWER: There isn’t a condition called “brittle veins”: Whoever told you that was trying to explain a symptom you have. They may have meant that your capillaries (the smallest type of blood vessel) break easily. That’s a cause of easy bruising. They may have meant that you have stiff blood vessels, from calcium or cholesterol. That’s a cause of high blood pressure. They may have been trying to draw blood or put in an IV and found that your vein “blew,” meaning the needle went through the vein entirely and you had bleeding under the skin. There are also some rare blood disorders causing blood vessels to become fragile, and sometimes inflamed. These can be quite serious, but I doubt you have one of these. You would have been referred to a specialist. While I understand why medical professionals will use nonspecific terms like these, they can lead to confusion. *** Dr. Roach regrets that he is unable to answer individual letters, but will incorporate them in the column whenever possible. Readers may email questions to ToYour-GoodHealth@med.cornell. edu or send mail to 628 Virginia Dr., Orlando, FL 32803.
